Medicare knowledge: Learning the basics
Dear Toni,
I am a confused baby boomer who needs to make my Medicare decision by November when I turn 65. I do not know where to start or what to do.
Can you please help simplify this ordeal? Thanks, Toni.
— Stephanie from Phoenix
Hi Stephanie,
Don’t feel alone, because someone will enroll in Medicare every eight seconds every day for approximately the next 10 years. Most boomers feel an urgency to learn all their Medicare options and are stressed over getting it right, because they know that one wrong move can jeopardize the retirement savings they worked so hard to build.
Below are some facts for those entering Medicare.
Enroll on time. The only way Medicare is automatic for someone turning 65 is when they are already receiving a Social Security check. If you are not receiving your Social Security check and not working full-time with employer benefits from either your or your spouse’s work, then you will want to enroll in Medicare Parts A and B via online at ssa.gov/medicare/sign-up. Those working full-time with employer benefits or who are covered under their spouse’s benefits may want to delay enrolling in Medicare Part A and Medicare Part B until they retire or lose their benefits for any other reason. If the employer’s benefit is a Health Savings Account, important Medicare rules apply.
Medicare is not free.
Medicare covers a lot, and there is a cost associated with Medicare Parts A and B. You have been paying tax dollars for Medicare, and the premium for Part A is at no cost. Medicare Part B has a premium that is means-tested and depends on how much you have earned for that year. In 2023, an average Medicare beneficiary pays $164.90 each month for Part B premium. The 2023 Medicare Part A (hospital) deductible is $1,600 — not once a year but every 60 days or six times a year. The 2023 Medicare Part B deductible is $226 once a year, with Medicare thereafter paying 80% of the Medicare-approved amount and you paying the remaining 20%. Many individuals purchase insurance to cover this 20% “gap.”
Learn Medicare’s alphabet soup: Parts A, B, C & D.
Medicare Parts A and B cover hospital, medical and provider expenses. Medicare Part C, known as Medicare Advantage, is another way of receiving your Medicare benefits. Part D is Medicare prescription drug plans that can be enrolled in as a stand-alone plan with a Medicare supplement with original Medicare or can be bundled in a Medicare Advantage plan.
Medicare covers a lot. Medicare Part A covers in-patient hospital, skilled nursing facility care, home health and hospice care.
Medicare Part B covers physicians’ services, outpatient surgery/services, lab/X-rays, MRIs, durable medical equipment, preventative services, etc.
Medicare doesn’t cover everything.
Medical services not covered under Medicare include vision, hearing and dental expenses, as well as longterm care.
There’s no network with original Medicare (with Medicare supplement/Medigap).
Your health care profession or facility bills Medicare directly.
Medicare Advantage may be a good option.
Know that you can choose between original Medicare (Parts A and B) or Medicare Advantage plans offered by private insurance companies.
Medicare also serves people under 65.
Those under 65 on Social Security Disability or end stage renal disease qualify when they meet Medicare’s requirements.
When someone visits the Toni Says office for a Medicare consultation, we tell them to forget everything they know about their old health insurance plans because Medicare is totally different.
Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. You can visit seniorresource.com/ medicare-moments to listen to her Medicare Moments podcasts and get other information for seniors. The publisher of Toni’s book, “Medicare Survival Guide Advanced” edition, is offering a $10 discount to Toni Says readers and friends.